Pharmaco-epidemiology of resistance and antibiotic intake.

Antibiotic exposure is one of the determining factors in the evolution of b acterial resistance. Antibiotic selective pressure involves those environme ntal conditions favouring the emergence and subsequent spread of antibiotic -resistant bacterial strains. Whatever the original means of acquisition of bacterial resistance, a suitable environment is required for its further d issemination: in an antibiotic-free environment, the resistant bacteria can not survive. Studies on antibiotic selective pressure have generally only f ocussed on one aspect, e.g., genetic, cellular; clinical, or epidemiologica l problems, without taking into consideration a more interconnected scienti fic approach. It is now time to consider antimicrobial resistance as an env ironmental issue, and to develop a pharmaco-epidemiological multidisciplina ry approach. (C) 2000 Editions scientifiques et medicales Elsevier SAS.